Addressing racial/ethnic disparities in the COVID-19 vaccination campaign
Addressing racial/ethnic disparities in the COVID-19 vaccination campaign
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解决 COVID-19 疫苗接种运动中的种族/民族差异
DOI：
10.1101/2021.04.21.21255878
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
J. Salomon
中科院分区：
文献类型：
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作者：
M. Reitsma;J. Goldhaber;J. Salomon
截至4月19日，所有16岁及以上的成年人都有资格接种COVID-19疫苗。不同种族/族裔群体之间不平等的疫苗接种率可能会加剧黑人、土著和西班牙裔社区之间在病例、住院和死亡方面的现有差异。方法从国家网站上提取截至2021年3月31日接种[≥]1剂疫苗的人群比例，按年龄分层，按种族/民族分开。将这些数据与美国社区调查的人口统计数据相结合，我们估计了每个州内种族/民族的相对接种率，即观察到的种族/民族接种疫苗的份额，除以每个年龄组内种族/民族的接种率与人口规模成正比的预期份额，这种方法使我们能够控制历史年龄为基础的资格。我们在三种情况下对一个州的每个普查区的疫苗接种规模进行了建模：1)不平等接种率持续存在的情况，2)在六周内不同种族/族裔群体的接种率平均的情况，以及3)接种率平均且各州采用优先考虑弱势普查区的基于地点的分配策略的情况。结果截至2021年3月31日，与黑人和西班牙裔成年人相比，白人成年人接种疫苗的比例不成比例。在各州，根据符合条件的人口规模调整后，白人的相对吸收率中位数是黑人成人的1.3倍（IQR, 1.2-1.4），白人的中位数是西班牙裔成人的1.4倍（IQR, 1.2-1.9）。在目前持续存在的接种差异下预测疫苗接种覆盖率，我们发现黑人和西班牙裔人口在成年人中的覆盖率将比白人人口晚近一个月达到75%。在其他情况下，我们发现，在不同种族/民族群体中平衡接种率的干预措施可以缩小但不能消除这些差距，并且可能需要将疫苗剂量的地理目标定位于弱势社区，以便在7月之前实现更公平的覆盖趋同。迫切需要采取干预措施，以消除COVID-19疫苗接种率方面的差距。消除获得疫苗的障碍和提高边缘化人群对疫苗的信心，可以缩小疫苗覆盖方面的差距。将这些干预措施与基于地方的分配战略相结合，可加快在因COVID-19而承受不成比例负担的弱势社区进行疫苗接种。
Background As of April 19, all adults aged 16 years and older are eligible for COVID-19 vaccination. Unequal vaccination rates across racial/ethnic groups may compound existing disparities in cases, hospitalizations, and deaths among Black, Indigenous, and Hispanic communities. Methods From state websites, we extracted shares of people receiving [≥]1 vaccine dose, stratified by age and separately by race/ethnicity, through March 31, 2021. Combining these data with demographic data from the American Community Survey, we estimated relative uptake rates by race/ethnicity within each state as the observed share of vaccinations for a racial/ethnic group, divided by the expected share if uptake across racial/ethnic groups within each age group were proportional to population size, an approach that allowed us to control for historical age-based eligibility. We modeled vaccination scale-up within each census tract in a state under three scenarios: 1) a scenario in which unequal uptake rates persist, 2) a scenario in which uptake rates are equalized across race/ethnicity groups over six weeks, and 3) a scenario in which uptake is equalized and states employ place-based allocation strategies that prioritizes disadvantaged census tracts. Results White adults received a disproportionate share of vaccinations compared to Black and Hispanic adults through March 31, 2021. Across states, relative uptake rates, adjusted for eligible population size, were a median 1.3 (IQR, 1.2-1.4) times higher for White compared to Black adults, and a median 1.4 (IQR, 1.2-1.9) times higher for White compared to Hispanic adults. Projecting vaccination coverage under persistence of current disparities in uptake, we found that Black and Hispanic populations would reach 75% coverage among adults almost one month later than White populations. In alternative scenarios, we found that interventions to equalize uptake rates across racial/ethnic groups could narrow but not erase these gaps, and that geographic targeting of vaccine doses to disadvantaged communities may be needed to produce a more equitable convergence of coverage by July. Discussion Interventions are urgently needed to eliminate disparities in COVID-19 vaccination rates. Eliminating access barriers and increasing vaccine confidence among marginalized populations can narrow gaps in coverage. Combining these interventions with place-based allocation strategies can accelerate vaccination in disadvantaged communities, who have borne a disproportionate burden from COVID-19.